OIG Flags Deficiencies in Post-Discharge Suicide Care for Medicaid Youth

In my travels to hospitals across the country and time spent in emergency rooms shadowing the critical work of social workers, I’ve seen firsthand the challenges they face in coordinating outpatient behavioral health follow-up
for children and adolescents coping with suicidal ideation, anxiety, depression, eating disorders, and other mental health conditions.

Recently, while visiting a children’s hospital in Florida, these struggles reminded me of an email I received from Dr. Hirsch about an OIG report released in September 2025. At the time, other CMS updates overshadowed it, but its findings are too important to ignore.

The OIG report, issued in September 2025, evaluated how often children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) receive follow-up care after hospitalization or an emergency department
(ED) visit for suicide-related issues and what barriers may be preventing timely care. The why now, for this report discussed how suicide is the second leading cause of death among American children aged 10–17, and
rates of suicidal thoughts and behaviors have risen sharply over the last decade. In 2023, nearly 225,000 insured children in this age group were treated in a hospital or ED for suicidal ideation or behavior. The report
discusses the value of the critical period immediately following discharge, especially the first week, that carries extraordinarily high risk for repeat attempts or suicide death. Timely follow-up care can not only lower overall
healthcare costs by decreasing rehospitalizations and emergency visits but frankly reduce risk and save lives.

OIG’s comprehensive analysis of Transformed Medicaid Statistical Information System (T-MSIS) data reveals several concerning trends. In 50% of hospitalizations or ED visits for suicidal thoughts or behaviors, children did not receive a follow-up visit within 7 days of discharge a timeframe most professional and public health organizations recommend as critical for safety and stabilization. And of that missed follow-up percentage, 21% did not have any follow-up visits in the 60 days post discharge, even though risk remains elevated well beyond the first week. When follow-up care occurred, 71% of visits were with behavioral health specialists such as counselors, social workers, psychiatrists, psychologists, and psychiatric nurse practitioners, while the remainder were delivered by other clinicians such as case managers and pediatricians.

To better understand low follow-up rates, OIG interviewed subject-matter experts from organizations such as SAMHSA, the American Foundation for Suicide Prevention, and the National Alliance on Mental Illness. The
consensus was that two main obstacles persist; there is a behavioral health provider shortage in the US, and there are systematic challenges to connecting children to care. In fact, the U.S. faces a nationwide shortage
of qualified behavioral health clinicians. More than 120 million Americans live in areas designated as mental health professional shortage areas with wait times for appointments spanning weeks to months. Even when
providers exist, families often struggle to navigate the system. Discharge planning may not result in scheduled follow-ups, and barriers such as lack of transportation, caregiver stigma, and difficulties accessing appointments
further hindering timely care.

To address this issue, the experts in the report recommended the value of bridge brief interventions, such as outreach ‘caring’ contacts, warm handoffs from acute to ambulatory providers and comprehendible safety
planning.